Question:
I noticed in the movie "A Beautiful Mind", twice a reference was made to insulin in the treatment of John Nash's illness. Was it common practice in the 50s to bring one's blood sugar down in the treatment of mental illness, or did the word "insulin" have a different meaning in those days?

Linda Kuehn
Las Vegas, Nevada

Answered by John Hsiao, M.D.:
Insulin coma therapy was a commonly used therapy for schizophrenia from the 1930s until the first antipsychotic drugs were discovered in the 1950s. It should not be confused with convulsive therapy, which was also used to treat schizophrenia (and many other mental illnesses) during the same period. Insulin coma therapy involved controlled dosing of insulin to induce a hypoglycemic coma lasting several hours. Treatments were given on a daily basis, and the low blood sugar sometimes resulted in seizures or irreversible coma. When effective medications became available for people with schizophrenia, insulin coma therapy was abandoned in the United States.

Answered by Robert Whitaker:
I'd like to add one note on how insulin coma therapy may have affected John Nash. In the 1930s and early 1940s, asylum physicians observed that this treatment, when administered multiple times, made patients less "self-conscious." The patients' thoughts would interest them less, and they would become less emotionally engaged. Manfred Sakel, the Austrian psychiatrist who invented the procedure, said that at times, the "whole level of personality is lowered." Obviously, this change in "being" would have posed a problem for a mathematician like Nash. In addition, in 1950, a long-term study found that only 6% of patients so treated remained socially recovered three years later, an outcome so poor, they wrote, that it suggested "that insulin therapy may have retarded or prevented recovery." Thus, one wonders today whether Nash might have returned to mathematics at a much earlier date if he had not been so treated.